Did I make the right decision switching speech therapists? What to do now?

Re: Did I make the right decision switching speech therapists? What to do now?

• kcisthebombdotcom member

  December 2014

  Honestly if I had a therapist that my child liked and was clicking with I probably would have held a meeting to voice my concerns before I ditched her but that doesn't really matter as what's done is done. I'm not surprised your therapist pushed for more preschool with a kid who was delayed and not progressing after 8 months. If finances are an issue maybe you can check out the y. They provide financial assistance, have a nationally accredited program and she could do that the other three days.

  

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• hopecounts member

  December 2014

  Has your daughter had a full and robust eval with a Dev. Ped.?

  It might help remove some of the questions.

  Most kids without an underlying significant issue would improve speech when placed in a preschool setting, it usually forces them to use words and they have peer models to copy. 

  This is also why I am so glad both DD's schools have observation booths so I can see what and how they are working on things. 

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• Love My Lil Princess 509 member

  December 2014 edited December 2014

  She had 3 evaluations last year in order to qualify for services: speech, an assessment with a developmental psychologist and someone in education (not sure what her exact specialty was.) She scored fine on the education one and above average with the developmental psychologist. Actually, she completed a task that he's only seen 4 kids ever be able to complete. He said most 4 year olds had a hard time with it.

  I get the feeling that the person who was in the room was a teacher at her school. Only reason I say this is bc she mentioned talking to the teacher friend who told her they have openings. The only time the ST told me DD wasn't talking much, was when she first started, for like the first month. DD was very shy last year at 2 1/2, but now talks to everyone. The ST actually went on and on come September how much DD was talking during her sessions and pre-school must be going great. Even then, at this point in time, I just feel like if DD is having "quiet sessions", then maybe she should be trying some other technique to get her talking. I voiced my concerns a few times that she still couldn't get the letter P for example and dropping the endings of her words. The ST would just say "Yeah I know."

  As far as homework, from what I saw from the other therapists at her agency and from what I've read a lot on here and other places, the ST should be giving at least something to do with your kid, even if you're blowing bubbles lol. Every other therapist would come our and specifically state what they did with the kid and how it went. To go 5-6 days between sessions and think having me color with her is going to help her articulation or reading magazines to her that she didn't finish reading to her during her session.

  Maybe she was repeatedly telling me she wanted to quit the agency bc she knows for certain she is quitting and didn't want to come out and tell me. Maybe she was hoping we'd find another therapist? I don't know. And telling a parent how inadequate the speech therapy is from the agency YOU work at, well that don't sound too re-assuring.

  Both DH and I went to speech therapy as young children. I pronounced my first name the same way DD does, which is funny. We actually went to the same hospital for speech. I was in and out in under a year. And I HATED going. That's one of my earliest memories that I had. Hiding under the table, crying and refusing to do anything for the therapist sometimes. DH was in speech for over 5 years and still today has trouble pronouncing certain words. He also went to 3 years of preschool before grade k, which seems like it didn't do much. I never went to preschool a day before starting grade K.

  Preschool for 3 year olds is extremely expensive in my area and I'm also a SAHM. Pre-K next year for 4 year olds is free in my state. DD does not qualify for any type of free preschool services now. So unless our ST was paying for a 5 day a week program at her school, I dunno. And even if we could afford it, I would put that money  towards private speech therapy or more speech therapy on top of the ones she was already receiving.

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• veggieroll member

  December 2014

  When we first started with EI, everyone including the OT told us that if we ever felt like DS would benefit better with a different therapist to switch anytime because some kids just don't work well with some therapists. I actually did swap out speech therapists.

  
  

  That is strange that she called the therapy inadequate unless she meant something like the kids need more therapy or something like that. But that's also weird that she said keeps telling you that she's thinking about leaving. I don't think DS's therapists would tell me they were leaving until they had a date or time frame in mind.

  
  

  It's not through the school system, but the private center DS goes to has interns come through pretty often. Maybe the extra person in the room just looked like a friend to your DD because they were both interacting with her?

  
  

  Would they be opposed to observation if you asked? DS's center doesn't have an observation booth or anything like that, but the parents can go back. They discourage doing it often because it can be distracting to the kids, but my husband's done it just to check out what they were doing with DS. Good luck with the new ST! Hope she works out better with her.

  DS 10/2012

  
  

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• Love My Lil Princess 509 member

  December 2014 edited December 2014

  -auntie- said:

  Love My Lil Princess 509 said:

  DD is 3 1/2 and started started speech the end of April last year from our DOE school system. She is only given 2 - 30 min sessions a week and had NO speech for the summer.

  Two 30 minute sessions are pretty typical of what a child with a speech delay would get in an IEP. I wouldn't expect her to recieve ESY at 3 1/2 for a stand alone speech delay as a young three either. More intensive services are generally reserved for children who are globally delayed.

   She ended up getting the therapist who evaluated her.

  Not unusual. The SLP who evaluated DS in 2nd remained his SLP through 6th. In order district, evaluators are assigned by the child's home school in almost all situation.

   Me and her became pretty friendly on a personal level and DD really likes her and talks about her all the time. Her main job is a ST at a pre-school and she works for the school agency part-time. DD was evaluated by her to have a severe expressive articulation delay, along with fronting and dropping, making her extremely hard to understand, except for me. Even I have to say "what" a few times a day though to certain things.
  

  What sort of preschool is this where she works? It's pretty unusual for a private mainstream preschool to have a staff SLP. Though there are districts who deliver some of their IEP services in a public preschool setting. I'm always suspicious of private and chain DCC cum preschools that bring in OTs and SLPs to evaluate as the might bring in the school photographer. Seems shady.

  It doesn't sound like she's progressing well. Have they ever considered apraxia? It could be she needs a very specific kind of treament- PROMPT. You aren't typically going to find this done in a public school setting.

  I'm also suspicious of getting "too friendly" with a service provider. Friendly is great, but it shouldn't be a kind of playdate relationship in most situations.

  From the get go, I have never been sufficient feedback on how DD does during her sessions nor given any nightly homework to do. She did give me flash cards to do drills and work on her final constant deletion.

  I would count this as homework. 

   Maybe once or 2x she told me that they were working on the P sound. Every week I still continued to ask what or how she did, and I get answers like "Oh good" then silence or "She listens so well." 

  Since she's over 3, she should have an IEP, no? Or are you in one of those states that allows parents the option of staying on a IFSP? 

  What are her written goals that you signed off on? Are you not getting written reports osn progress toward those goals? These are often done quarterly and follow the report card marking periods of your district schools. The goals would specify what she needs to learn and her progress toward mastering that.

  DD would come out with Scholastic 4 page magazines in her hand. The ST would tell me to finish reading them to her at home. So she's just reading to her? Sometimes she'd say "We learned about fire safety or about the Fall." Then she'd hand me a blank coloring sheet and say you can do this with her. A coloring sheet.? Or a worksheet where you match pictures. 

  DS had a lot of this when he was in speech services in the primary grades. 

  There was often a theme that overlapped his school curriculum that was part of the speech instruction. DS's coloring pages where part of a multisensory approach to his S&L issues. TBH, until I understood the speech program being used and the multisensory approach I seriously side-eyed the worksheets as WFT? I should have asked about this sooner than I did.

  I thought there was some method to what she was doing, but started getting concerned about what was going during her sessions. The ST made a big thing about enrolling her in preschool saying it would help with her speech. We had NO plan on sending her this year at 3, but we did thinking it would help. We are on a strict budget to afford this. We found a low cost, play based preschool and DD LOVES it. She goes 2x a week for half a day.But as far as helping her speech, no help at all.
  

  I totally agree that preschool enroll can only benefit your child. You might not see a tangible result other than her happiness to go. But she's learning to be social and has the advantage of peer models who are communicating appropriately. The experience may be preventing her from falling behind peers in other developmental areas. That's huge and not something you can do at home or in a clinical setting.

  The ST has mentioned 3 times in the past few months how she wants to quit working for the school system, how parents are always canceling on her and complaining about the commute for her. Then she said she feels the therapy the kids get from the agency is inadequate. Huh? I mean she works there. Isn't the THERAPIST responsible for making sure the kid gets what they need.

  It's sort of inappropriate for her to be pissing in your ear about clients. Very unprofessional. But I feel her pain; people who get stuff for free (i.e. school services) don't always value it. Especially if they're also getting services privately.

  As for her comment about kids getting inadequate services? Again, not an especially professional rant, but she's bound by the IEPs of her students which were written by the team and signed off by the parents. Ultimately, it's the parents job to make sure the child's needs are met.

  There's also the notion that IDEA is meant only to serve educational needs- it's not meant to be a 360* service. Among my ASD mom friends, we all provided at least some privately funded services for our children. I know my one apraxia-mom friend did private PROMP with her DS from 3 until he was about 12 and insisted on quitting. She funding it again now that he's in grad school.

  
  

   There were also times the ST would show up late cutting into DD's session time. Or one time she texted me asking me for a time change for that day. I said ok. In convo after the session, she said "I'm glad this time works for you bc I got new cases at my school I work at. If it didn't, you'd have to be assigned a differed ST." So, she would just drop us like that?
  

  It was unprofessional to be habitually late. But sometimes shit happens. Traffic. Dropping a dx on a newbie parent who needs her to stay with her. You just never know.

  Your child's IEP likely stipulates only the title/roll of the person providing the service not a specific individual. They can swap out SLPs if the current one can't continue to service her IEP. Depending on scheduling, there were times when DS had every 4th appointment with some random SLP who had no clue about his issues. It was frustrating, and I would have died on the hill, but his other SLp was epic, so I let it pass. 

  During DD's sessions at the agency, sometimes there would be 3 other kids with 3 therapists in a room. I would hear them talking to DD, though she was supposed to be getting a 1:1 session with ONLY her therapist. I KNOW this was not helping DD. We were lucky that the ST started letting us come 1x a week to her office at the preschool she worked at, but DD didn't seem show any improvement from the change of locations. 

  In some situation 1:1 SLT makes sense, but sometimes including other children can help the child actually globalize the skills she's trying to master into a more natural setting. There's no real benefit to a kid learning to talk solely to an indulgent adult. DS's SLT services were split in elementary and exclusively group in middle school.

  But she's not improving anyway. So there's likely a bigger issue at hand. Eight months is a long time. It would make sense to obtain a private eval with the top SLP for apraxia in your community. Your pedi might know who that is. 

  I sort of felt stuck throughout this bc we couldn't afford private speech and bc her ST was so nice to DD and I. I kept thinking DD would progress. A few weeks ago I started thinking that perhaps somehow, someway we needed to come up with the money for private speech.

  At least to get a second opinion.

  Last week, the last time I saw her, we had a convo that sort of made me "know" DD needed a new ST. She comes out, I ask what they did, I get  "Oh the gingerbread man." Then I ask, "Is there anything for me to work on her with?" And get told  AGAIN no. So I said, "Ok, bc I really don't see her speech getting any better." She then tells me she was going to wait until after the new year, but she's concerned her language isn't at where it should be and how she was really quiet again. Also, she thinks DD needs more hours of speech week. This was never expressed to me before and the kid talks up a storm at home, in stores, etc. So perhaps whatever she is doing isn't getting DD so speak much.  Then she confuses me and starts saying how "her school" has a 5 day a week program where they could work on her numbers and we could go that "route." How pre-k now requires so much (yeah I know, I'm certified to teach). I was thinking she meant to bring her 5 days for speech, but what she wanted was for me to enroll DD at her school. What does this have to do with speech problem? I said to her, "She's enrolled already in a school we like and I'm not pulling her out mid year." She seemed kind of disappointed when I said that. Then she says how she doen't want to push her school on me. What was she doing then? Then "Oh you have an education background, how do you feel she is doing with her numers." I said fine, bc I think she is doing fine. AGAIN she says how she thinks she's going to quit working at the school agency. So how was DD going to even stay with her for speech services then? I just didn't understand what she was getting at and sort of felt like she was deflecting the fact that whatever she is doing with DD is not working Also, making it seem that DD's preschool is inadequate.

  It's hard to say.

  You sound so frustrated. I would be, too. There have been times when DS's psych and SLP did things with him that seemed really off-the-wall beyond my comprehension. I asked them to explain the whys to what they were doing and they did so it made sense and gave my buy-in.

  Not knowing the backstory, it's hard to know if you have chosen a mediocre preschool and hers is really the superior choice. I'm a little suspicious they have an SLP unless it's an intergrated model. 

  If there's one thing I've learned in my years of Spedworld, it's that more of something that isn't working won't work better. If her issue is apraxia, services aimed at a delay around going to help. DS has dyslexia; we sent him to a school to get differentiated instruction for his unique issue rather than have tutoring with a teacher using a curriculum that we know wasn't working.

  I told DH what had happened and he said maybe she gets financial kickbacks from getting people in her school. I was pissed off too that yet again I'm ASKING to help my kid at home, but get told there's not a single thing I can do. From what I read, that doesn't make sense. So I made the decision to call my case coordinator, change agencies and get a new therapist. And I STILL feel bad that I did this bc she was so nice to DD and I. She even gave me paperwork to sub at her school if I wanted. But I felt like we were getting NO WHERE with DD's speech. Also, DD told me there was another lady in the room with her that day. Her ST really should not be having any of her friends from her school in the room with DD. The next day she texted me saying she was sorry to see us leave and when her IEP evaluation date is.

  That wasn't the best way to manage this. The thing is, these people talk among themselves. Often they're work buddies not only with the SLPs who also work at the preschool level but with the ones who serve at the elementary level. You risk being that mom. 

  In the future, it's best to ask the person for an explanation of things that make no sense to you. If you do feel the need to try a fresh perspective, it's best to offer an explanation of why. Of course, once you get to elementary, you'll get the building's assigned SLP, so this won't be an issue.

  I wouldn't get my panties in a bunch over another adult in the room. It could have been a supervisor observing the SLP, she could have been mentoring a grad student or training a new agency hire. 

  I started googling stuff recently and began thinking maybe DD has apraxia, though that has never been mentioned to me. Maybe that's why she hasn't made any progress and she's so hard to understand when she speaks? Though, it may just be she had bad speech therapy. So, she's starting up in 2 weeks with the NEW therapist. It will only be DD and the therapist in the room too. DD keeps asking when she's seeing her old ST and I feel really bad saying she won't see her again ;(

  I really don't get why you are so focused on "just DD and SLP in the room". Speech in isolation isn't mastery. How will you know if she can take her skills to the next level and use them appropriately? 

  I do think you might be right about the apraxia, though. The thing is, not all SLPs are capable of managing this disability effectively. According to my apraxia mom friend, these's no one great in our district- DS's elementary SLP is pretty good, but not as good as the private one she hired. 

  So do you all think I did the right choice by switching?

  Probably. TBH, I probably would have as well.

   And why do I feel bad that we switched? 

  Maybe because of the unprofessional "friendly" relationship you had? Maybe because you didn't really give her a chance to explain her methods. I get it though, I feel guilty when I change hair stylists even when it's just a matter of convenience. 

  I know speech can be a long process, but I've also heard stories about speech from the school system that sucks and them doing a one size fits all kind of therapy. I'm just really frustrated and feel like we wasted almost a year and got no where. Would you ask her new ST if I should have her re-avaluated again, or do they do this at her annual IEP meeting come March? 

  Why wait until March. Reopen the IEP now and have them R/O apraxia. She should have improved by now; it's worrisome that she hasn't. 

  Would you explain to the new ST what happened with the old ST? I am just really worried she's going to go into pre-k 4 next year being as hard to understand as she is now. I even scheduled a hearing test for her next week. Help!

  That's a real risk and one that could have both social and academic consequences. If she's not processing speech sounds effectively than she might have trouble learning to read. If her classmates can't understand her, they may not include her as much. Unfortunately, this is more of a girl thing- girl play is often very verbal. You're so wise to be proactive on this.

  If the SLPs are both from the same agency, the old one will have filled the new on in on her issues. But you should explain your concerns without throwing the old SLP under the bus.

  
  

  
  The 2 ST's are from different agencies. People switch ST's all the time. I did not go "at her" saying oh you're a bad ST or bad mouth her to case coordinator. I wouldn't do that. My discussion to the case coordinator was that I did not see any progress and I would like to switch agenices and what the process was. This agency is closer to my house too. Not sure how any of that is going to classify me as THAT mom.

  While scholastic handouts may be useful to your school age child, I do not understand, nor was it EVER explained to me how this is going to be useful to a 3 year old. The ST when she was telling me over and over how she thinks she is quitting this agency and the services the kids receive is adequate, said outright how she doesn't think it's beneficial to have 3 kids in a room at a time during sessions. She said this new agency office had space issues (they changed buildings over the summer), so this is why it was done. I still feel more comfortable having my daughter in a room alone with just her ST.

  She works at a PRIVATE Montessori (sp) pre-school. Most of the kids she works with are the children from the school. Not sure if they are coming in already with IEPs or if she evaluates them per the parents request. But like I previously posted, DD loves her current school and I'm happy with her there. Plus, there is no way we can afford 5 day a week preschool now at this or ANY school. It also seemed that becoming "friendly" with the parents was her thing. As she was yelling out to another parents once how she just "texted" her telling her something funny and told me in convo how she has become friendly with many of her kids parents.

  I think I will take your advice though and have her re-evaluated. Thanks for all your helpful advice! 

  Also, you don't think I will sound like "THAT" "know it all mom" who isn't a ST, going in to the new ST saying "Oh, I think my kid has apraxia?"

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• Love My Lil Princess 509 member

  December 2014 edited December 2014

  I forgot to include, she was the one who wrote my kids IEP. I never got any written progress reports or notes. I never knew I was supposed to get that. Just "She did good or she was quiet." That was it. Also, I'm getting her hearing tested next week too.

  DH thinks I'm off my rocker doing all this, but I'm concerned, very concerned.

  I also got good new yesterday that our insurance now will cover speech at 80% once our deductible has been met, but only for 24 sessions per calendar year. Last year ours was met in May, so we can also get private then. Not sure how a private place would feel about only having her for 24 sessions, unless I don't tell them.

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• hopecounts member

  December 2014

  Depends on how you phrase it.

  'I am concerned that DD may have apraxia as she has shown little progress despite having speech twice weekly over the past year, can you evaluate her for that as you do her intake?'

  isn't going to come across as 'know it all' since you are seeking their advice/opinion

  'My kid must have apraxia so treat her accordingly' would for obvious reason.

  Tone and word choice make a huge difference in how something comes across

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• macchiatto member

  December 2014

  I don't have a lot to offer here but the one thing I'm wondering is if it was ever an option for you to sit in on at least some of her sessions. Then you would have had a much better idea of what they were working on, how DD was responding, what may have seemed more or less effective, etc. @auntie, is this something where different therapists just have different preferences, or it depends on how the child responds? 

  
  

  I've sat in on 95% of my son's therapy sessions over the past 3+ years (a mix of Early Intervention/clinic, in-home, private, plus itinerant services through the school district) and I found it really helpful for follow-up and to understand what they were doing and why and how I could continue working with him at home. I was open-minded re being present or not but the therapists have all either encouraged it or just said it was really up to me. The current agency he sees for ST and PT (in-home) even puts in their initial agreement that they want the parent to be a part of the sessions since the therapists are with the children such a small part of the time and the parents are key for follow-through throughout the week. Is this unusual? Would it be helpful for OP to ask for with the next therapist, or does that really just depend on how the child responds with vs without the parent in the session? It seems like that might ease some of the frustration of not knowing what's going on, and would help with the issue (that would concern me as well) of one adult being alone in a room with a non-verbal child.

  fraternal twin boys born january 2009

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• CCinLove member

  December 2014

  I also think it's odd that you weren't included in the sessions.  I almost always sat in on my son's speech therapy.  When I didn't, it was always my choice.  I would not have been comfortable with it any other way.  Most of his progress came from me and H reinforcing all of the things that his SLPs were working on with him in the 167 hours a week that they weren't with him.  Without knowing what the sessions looked like, it's impossible to know if she was doing a good job or not.  Most of my son's sessions were play...Thomas the Tank Engine, board games, catch, drawing, etc.  If I hadn't been in the room, I would not have witnessed the ingenious ways that his therapists used the fun to get him to meet certain goals.  He can't have a turn until he makes a certain sound properly, showing proper turn taking/sharing, etc.

  
  

  That being said, you made the right choice to switch.  You don't seem to trust her, and there seems to be missing communication.  My son's first SLP was subpar, and I wish we had switched sooner.  Like you, she couldn't give me any explanation for why he wasn't making progress, and continued to do the same ineffective things over and over again.  He started to make progress as soon as he got a new SLP that did something different.  Not all SLPs are created equally.  I would probably have let her know that I was going to pursue the other agency because it was closer to my house as to not create any conflict if possible.

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• macchiatto member

  December 2014 edited December 2014

  That makes a lot of sense; thank you.

  
  And yeah, for us it probably was a little different from many because his earlier services were:
  * Early Intervention, and he continued with those same therapists for a while after he turned 3.
  

  * When he did have an IEP from 3-4.5, his services were all itinerant/in-home or occasionally they had us meet them at the school playground. 

  
  

  And then like I mentioned the agency who provides his ST (for pragmatics) and PT now provides in-home therapies and require the parent to be included.

  
  

  He doesn't have an IEP now since he was deemed to not qualify through our new district but yeah, if he were getting therapies at school I wouldn't expect to sit in on those. I've always been open to being present or not based on what the therapist thought would work best with him but I feel like I've learned a lot from sitting in on all those sessions and for X it has seemed to work out well.

  
  

  That's a great point about the sped world being small and being careful not to burn bridges. 

  fraternal twin boys born january 2009

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